<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html dir="ltr" xmlns="http://www.w3.org/1999/xhtml">
<%@include file="/WEB-INF/taglibs/common/taglibs.jsp" %>

<head>
    <title><spring:message code="sp.stop_payment.title"/></title>
    <meta content="text/html; charset=utf-8" http-equiv="Content-Type"/>
    <link rel="stylesheet" href="<c:url value="/css/styles.css"/>"/>
    <script src="<c:url value="/javascripts/common.js"/>"></script>
</head>

<body>
<div class="page">
    <%@include file="../../top_menu.jsp" %>
    <table width="100%">
        <tr>
            <td>
                <c:import url="/WEB-INF/jsp/menu/checks_menu.jsp"/>
            </td>
        </tr>
        <tr>
            <td>
                <%@include file="/WEB-INF/jsp/include/messages.jsp" %>
                <br/>
            </td>
        </tr>
        <tr>

            <td>
                <form id="role" method="post">
                    <%@include file="../common/search_checks.jsp" %>
                    <p>&nbsp;</p>
                    <table width="985" height="287" class="formTable">
                        <tbody>
                        <tr class="formHeader">
                            <td colspan="7"><spring:message code="sp.stop_payment.label.enter_check_detail"/></td>
                        </tr>
                        <tr>
                            <td width="151" class="label"><label for="label3" class="inline"><spring:message code="sp.stop_payment.label.check_no"/><span class="req"> <font color="#FF00FF">*</font></span></label></td>
                            <td width="147"><input name="postal_service2" size="21" type="text"/>
                            </td>
                            <td width="116" class="label"><label for="label" class="inline"><spring:message code="sp.stop_payment.label.order_id"/><font color="#FF00FF">*</font></label></td>
                            <td width="148"><input name="postal_tracking_number2" size="21" type="text"/>
                            </td>
                            <td width="154" class="label"><label for="label" class="inline"><spring:message code="sp.stop_payment.label.tran_id"/><font color="#FF00FF">*</font></label></td>
                            <td width="147"><input name="mailing address2" size="21" type="text"/>
                            </td>
                        </tr>
                        <tr>
                            <td height="30" class="label"><label for="label" class="inline"><spring:message code="sp.stop_payment.label.date_printing"/><font color="#FF00FF">*</font> </label></td>
                            <td><input name="zip_code2" size="21" type="text"/></td>
                            <td class="label"><label for="label" class="inline"><spring:message code="sp.stop_payment.label.order_date"/><font color="#FF00FF">*</font> </label></td>
                            <td><input name="mailing_city2" size="21" type="text"/></td>
                            <td class="label"><label for="label" class="inline"><spring:message code="sp.stop_payment.label.originator"/><font color="#FF00FF">*</font></label></td>
                            <td><input name="date_of _posting22" size="21" type="text"/>
                            </td>
                        </tr>
                        <tr>
                            <td class="label"><spring:message code="sp.stop_payment.label.date_picked"/><font color="#FF00FF">*</font></td>
                            <td><input name="account_no22" size="21" type="text"/></td>
                            <td class="label"><label for="label3" class="inline"><spring:message code="sp.stop_payment.label.batch_id"/><font color="#FF00FF">*</font> </label></td>
                            <td><input name="date_of _posting23" size="21" type="text"/></td>
                            <td class="label"><label for="label" class="inline"><spring:message code="sp.stop_payment.label.taxpayer_balance"/><font color="#FF00FF"> *</font></label></td>
                            <td><input name="date_of _posting2" size="21" type="text"/></td>
                        </tr>
                        <tr>
                            <td class="label"><label for="label3" class="inline"><spring:message code="sp.stop_payment.label.taxpayer_ssn"/><font color="#FF00FF">*</font></label></td>
                            <td width="147"><input name="postal_service2" size="21" type="text"/>
                            </td>
                            <td class="label"><label for="label" class="inline"><spring:message code="sp.stop_payment.label.taxpayer_fn"/><font color="#FF00FF">*</font></label></td>
                            <td width="148"><input name="postal_tracking_number2" size="21" type="text"/>
                            </td>
                            <td class="label"><label for="label" class="inline"><spring:message code="sp.stop_payment.label.taxpayer_mn"/><font color="#FF00FF">*</font></label></td>
                            <td width="147"><input name="mailing address2" size="21" type="text"/>
                            </td>
                        </tr>
                        <tr>
                            <td class="label"><label for="label" class="inline"><spring:message code="sp.stop_payment.label.taxpayer_ln"/><font color="#FF00FF">*</font></label></td>
                            <td><input name="zip_code2" size="21" type="text"/></td>
                            <td class="label"><label for="label" class="inline"><spring:message code="sp.stop_payment.label.spouse_fn"/></label></td>
                            <td><input name="mailing_city2" size="21" type="text"/></td>
                            <td class="label"><label for="label" class="inline"><spring:message code="sp.stop_payment.label.spouse_mn"/></label></td>
                            <td><input name="date_of _posting22" size="21" type="text"/>
                            </td>
                        </tr>
                        <tr>
                            <td height="36" class="label"><spring:message code="sp.stop_payment.label.spouse_ln"/></td>
                            <td><input name="zip_code2" size="21" type="text"/></td>
                            <td class="label"><label for="label" class="inline"><spring:message code="sp.stop_payment.label.spouse_ssn"/></label></td>
                            <td><input name="mailing_city2" size="21" type="text"/></td>
                            <td class="label"><label for="label" class="inline"><spring:message code="sp.stop_payment.label.status"/> <font
                                    color="#FF00FF">*</font></label></td>
                            <td><input name="mailing_city2" size="21" type="text"/></td>
                        </tr>
                        <tr>
                            <td class="label"><spring:message code="sp.stop_payment.label.amt"/> <font color="#FF00FF">*</font></td>
                            <td><input name="zip_code2" size="21" type="text"/></td>
                            <td class="label">&nbsp;</td>
                            <td>&nbsp;</td>
                            <td class="label">&nbsp;</td>
                            <td>&nbsp;</td>
                        </tr>
                        </tbody>
                    </table>
                    <p>&nbsp;</p>
                    <table width="985" class="formTable">
                        <tbody>
                        <tr class="formHeader">
                            <td colspan="7"><spring:message code="sp.stop_payment.label.stop_payment"/></td>
                        </tr>
                        <tr>
                            <td width="122" class="label"><label for="service" class="inline"><spring:message code="sp.stop_payment.label.message_title"/><font color="#FF00FF">*</font> <span class="req"> </span></label></td>
                            <td width="150"><input name="postal_service" size="21" type="text"/>
                            </td>
                            <td width="96" class="label"><label for="tracking_number" class="inline"><spring:message code="sp.stop_payment.label.message"/><span
                                    class="req">
                  <font color="#FF00FF">*</font> </span></label></td>
                            <td width="205"><textarea name="textarea" cols="30" rows="5"></textarea>
                            </td>
                            <td width="85" class="label"><label for="address" class="inline"><spring:message code="sp.stop_payment.label.desc"/></label></td>
                            <td width="255"><textarea name="textarea3" cols="30" rows="5"></textarea>
                            </td>
                        </tr>
                        <tr>
                            <td class="label"><label for="zip_code" class="inline"><spring:message code="sp.stop_payment.label.inform_bank"/></label></td>
                            <td><select name="select2" style="width:150px;">
                                <option value="1" selected="selected">E-mail</option>
                                <option value="2">Phone</option>
                                <option value="3">Fax</option>
                                <option value="4">Text Message</option>
                            </select></td>
                            <td class="label"><spring:message code="sp.stop_payment.label.reason"/> <font color="#FF00FF">*</font></td>
                            <td><select name="select" style="width:150px;">
                                <option value="stolen" selected="selected">Stolen Checks</option>
                                <option value="missing">Missing Checks</option>
                                <option value="lost">Lost Checks</option>
                                <option value="burnt">Partialy /fully damage check</option>
                                <option value="dup">Duplicate or Double Payment</option>
                                <option value="miss">Miss Printed or Incorrect Amount</option>
                                <option value="theft">Identity Theft</option>
                                <option value="other">Other - please type reason</option>
                            </select></td>
                            <td class="label"><spring:message code="sp.stop_payment.label.reason_detail"/><font color="#FF00FF">*</font></td>
                            <td><textarea name="textarea2" cols="30" rows="5"></textarea></td>
                        </tr>
                        <tr>
                            <td class="label"><spring:message code="sp.stop_payment.label.check_image"/><font color="#FF00FF">*</font></td>
                            <td><input type="file" name="logo2" id="logo23"/></td>
                            <td class="label"><spring:message code="sp.stop_payment.label.police_report"/><font color="#FF00FF">*</font></td>
                            <td><input type="file" name="logo2" id="logo23" /></td>
                            <td class="label">&nbsp;</td>
                            <td>&nbsp;</td>
                        </tr>
                        <tr>
                            <td><input name="submit3" type="submit" class="ui-button ui-state-default ui-corner-all"
                                       value='<spring:message code="sp.stop_payment.label.stop_payment"/>'/>
                            </td>
                        </tr>
                        </tbody>
                    </table>

                    <%@include file="../common/file_upload.jsp" %>

                    <br/>

                    <p>&nbsp;</p>
                </form>
            </td>
        </tr>
    </table>

    <div class="contentArea">
    </div>
</div>
<%@include file="/WEB-INF/jsp/include/footer.jsp" %>
</body>
</html>